Statistics - In the general population, 12% of women - one in eight - will be diagnosed with breast cancer sometime in her life. Gloria joined that club in the spring of 2022 when I found a lump in her left breast. It was treated with a lumpectomy and we assumed that would be the end of it. And, in most regards, it appears it was. No return of the same cancer within five years is the usual yardstick for claiming a cure and while we are only somewhat better than three, there has been no indication of its return.

But the human mind doesn't deal well with statistics as they relate to random events as most breast cancers are. Our brains are built to see patterns, whether there is one present or not. So that one-in-eight statistic for a woman who has had breast cancer may prompt her to believe she is then in the clear - she was one of the unlucky ones, but at least now she is done with it.

That is not how it works!

A woman who has had breast cancer runs the same statistical likelihood of having a new unrelated cancer in the future. It is like flipping a coin. There is a 50-50 chance it will land with the head side showing. But a second toss is not influenced by the first, so the chances of it turning up heads on the next flip are still 50-50.

Unfortunately, Gloria can attest to this fact. Early this August, cancer was discovered in her right breast.

Aggressive Screening - Since the 2022 cancer had been missed by her regular mammogram, probably because her breasts are more radiologically dense than those of many women, it was decided in the future she should be screened more aggressively. Those subsequent scans were all clear until the January 27 one of this year. It showed some changes in the right breast that could easily have been due to normal aging.

But further changes seen in her July 31 screen prompted a biopsy. That was completed August 6 and we received the unwelcome news on August 14. But while it was cancerous, it appeared to be only about 2 millimeters long. Her 2022 cancer had been 15 mm - a bit more than half an inch. So this new one appeared to be much smaller, and we hoped that meant it was detected earlier and so would prove to be even less troublesome than the earlier one had been.

Pathology Report - Once the cells taken from the site revealed their cancerous nature, they were tested for a number of additional traits. A little high school biology review might help with what follows.

Each body cell contains strands of DNA which serve as patterns to construct the various proteins - clumps of chemicals - that are what the body's cells are made of. Unlike nonliving things, cells can use the information in that DNA to make copies of themselves to create new cells.

The need for new cells is obvious when there is a loss due to an injury or a youngster is growing. But the need for some replacements arises from the fact that some cells are programmed to commit suicide. Some of these are never replaced. When a child is developing in the womb, the individual fingers are connected, Cells between them commit suicide to produce individual fingers.

Others are programmed to commit suicide because many of our organs cannot function well with a large number of cells that are of declining effectiveness. So cells in these organs are programmed to die early so they can be replaced by younger well-functioning ones.

Taken together, the replication of cells involves a delicate balance. Due to slight errors during duplication process, a replacement cell rarely performs exactly as its predecessor. If a new cell has a change that is a hindrance to its intended operation, it may die prematurely and require a quick replacement. But an error might also result in a cell that replicates when not needed or fails to respond to programmed death. These are cancers.

Breast Cancer Traits - A breast cancer is tested for four traits that provide clues on how aggressive it may be and what treatments it may be susceptible to.

Before looking in detail at the results from the 2022 and 2025 pathology reports, one thing that jumps out - they are somewhat different. If the two matched closely, it could be surmised that a stray cell or two from Gloria’s 2022 cancer had escaped treatment, ended up in the other breast, and seeded a new colony. These differences mean this new cancer is just that - a new flip of the coin, unrelated to the earlier one!

A breast's function is to provide nourishment for a youngster, and both estrogen and progesterone play critical roles in preparing and supporting a woman’s body for childbearing. So it would be reasonable that most breast cells would respond to these hormones - and they do. Approximately four out of every five (80%) breast cancers are composed of cells that respond to estrogen as a signal to duplicate.

(1) ER and (2) PR - These two markers are a measure of the percentage of cancer cells that contain Estrogen Receptors (ER) and Progesterone Receptors (PR). Since those cells use the presence of these two hormones as a signal to reproduce, suppressing the creation of estrogen and progesterone will tend to stop the growth of these cancers. However, for pre-menopausal women, doing so will also bring about menopause.

The principal source of these hormones in women are the ovaries. After menopause, this source almost disappears. But there are other places it is created in much smaller amounts. These hormones also play a role in such diverse areas as mood, the blood circulatory system and bone health. These roles at one time routinely led to prescribing hormone supplements for women who were post-menopausal. But after it was discovered that so many breast cancers are encouraged to grow by estrogen, this practice was largely abandoned.

But because of the positive effects these residual hormone amounts have on the body, drugs have been developed that target the estrogen receptors in breast tissue only. Some work by blocking the receptor, while others work by degrading the receptors so they become unresponsive.

(3) HER2 - Human Epidermal Growth Factor Receptor 2 (HER2) refers to both a gene and the protein it creates. As mentioned before, our genes are used as patterns to create the proteins that are what our cells are made of. This particular protein promotes cell growth and prods nearby blood vessels to grow toward the cell to bring nutrients to support that growth.

A common situation with cancerous cells is the HER2 gene creates too many of these proteins, leading to rapid growth. Like so many aspects of biology, these are essential activities for continued life, but too much of a good thing becomes a bad thing!

A positive HER2 rating means there is too much. At one time, this was associated with particularly lethal cancers. But treatments targeting this process have pretty much turned that situation around, making these easier to treat than those that are negative.

(4) Ki 67 - Kiel University in Germany is the source of the “Ki” part of the name and “67" refers to the container number out of 96 where it was located. It was discovered in about 1983. It is a molecule present in the cells of mammals only when the cell is undergoing duplication. The number is the percentage of cells that are in the process of reproduction at the time of the analysis.

It is impossible to establish an overall baseline rate ... meaning, the rate that maintains a person just as they are. Different body tissue types normally have different rates. Cells that are exposed to abuse, such those of the skin or intestines, have short lives and so must duplicate often. Others, such as those in bones, reproduce rarely. Breasts consist of a variety of types - some create the milk, others deliver it to the nipple, yet others provide physical support, etc. Generally, duplication rates drops as we age, yet will increase if injuries create the need for repair.

Some researchers have set a “worrying” threshold for breast cancer at 15%, while others set it as high as 30% In any event, Gloria’s were well below any of the common thresholds.